Insurance companies fail epilepsy patients

Epilepsy patients face many challenges, but one of the biggest barriers to quality of life comes from the very entity that should be should be helping — rather than hindering —their health.

Insurance companies are increasingly forcing epilepsy patients to try other drugs before covering the cost of prescribed treatments, jeopardizing their ability to drive and even putting their employment at risk. Fortunately, Florida lawmakers may soon make life a little easier for people with epilepsy.

More than 360,000 Florida patients suffer from epilepsy, a neurological disorder that can cause fainting, painful seizures and even temporary paralysis. Fortunately, as many as 85 percent of people with epilepsy can control their seizures and other symptoms through proper drug treatment. However, when patients are restricted from accessing prescribed treatments, they have a high risk of experiencing sudden seizures and other complications.

A common tactic used by insurance companies to restrict epilepsy patients (and other patients with chronic conditions) from accessing the treatments their doctor prescribed is called “step therapy” or “fail first.” Step therapy forces patients to try the insurer’s preferred sequence of treatments — and document their ineffectiveness — before the company will cover the treatment their doctor originally prescribed.

Patients treating epilepsy can be particularly susceptible to adverse reactions from medications that differ from the treatments their doctors prescribe. Encouraging them to adopt a trial-and-error strategy to find an effective treatment forces many to risk severe reactions — something insurance companies might appreciate if they saw a person with epilepsy as often as treating physicians do.

Denying prescribed treatments has tremendous consequences for epilepsy patients, beyond exacerbating the severity of their symptoms. People with epilepsy who go without treatment may experience uncontrolled seizures, which put them at increased risk of losing their driver’s license, their professional certifications or even their jobs.

It is unconscionable for insurance companies to require a person with epilepsy to risk seizures that disrupt their daily lives — or worse — simply so insurers can determine if a cheaper treatment will work. Often the cost-savings insurance companies seek by imposing step therapy are mitigated by the costs incurred by patients who fail on the insurer’s preferred medication. A 2009 study found, in fact, that step therapy patients experience more emergency room visits and can increase total health care expenses for insurers.

There is hope for people with epilepsy in Florida and other patients with chronic conditions who are forced on step therapy. SB-98, a bill making its way through the Florida Senate, would exempt patients from step therapy protocols if the prescribing doctor expects the insurer’s cheaper alternative to be ineffective based on the patient’s medical history. The bill received unanimous support from the Florida Senate’s critical Banking and Insurance Committee earlier this month.